Fuel Purchase Tax Credit Claim Form
Submit your claim for a fuel purchase tax credit by providing the required purchase and claimant details.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Are you submitting this claim as a business or an individual?
*
Business
Individual
Business Name (if applicable)
Tax Identification Number (Last 4 digits only)
*
Vehicle or Equipment Used for Fuel
*
Fuel Type
*
Please Select
Gasoline
Diesel
Propane
Natural Gas
Other
Date of Fuel Purchase
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Fuel Quantity Purchased (in gallons or liters)
*
Fuel Supplier Name
*
Upload Purchase Receipt
*
Upload a File
Drag and drop files here
Choose a file
Cancel
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Reason for Claim (e.g., type of use, exemption reason)
*
Submit Claim
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